Kaiser vs. Cigna/Centura in CO? (Denver: insurance, jobs, hospitals)

[JourneyCC]

So Kaiser is HUGE in Southern CA, but not so much Cigna and never heard of Centura (I"m a RN).........anyhow, just wondering which is most popular and if anyone had any recommendations?

Journey

[enigmakairos]

I'm facing the same options from my new job, and though my previous experiences with Cigna didn't give me the warm-fuzzies, there were no major issues. Furthermore, under no circumstances would I ever place my health care in the hands of Kaiser Permanente. I simply would never willingly limit my options to one (and specifically THAT system.)

My mother was misdiagnosed by doctors at Kaiser about a decade ago. She knew they were wrong, but was denied the choice of getting a second opinion from anyone, period. Nearly lost her life. She had a cancerous tumor the size of a grapefruit. No testing was done via Kaiser. I can't tell you how many people I've met with similar stories about them. In fact, never met anyone who liked their insurance with Kaiser. Talked to people at my new place of employment about my health care options and they darn near made the sign of the cross and reached for garlic and holy water at the mention of the name.

Hope that helps.

[tfox]

One advantage of Kaiser, as opposed to other systems, is that it may be your only option in attempting to acquire certain types of coverage on an individual (as opposed to group) basis. One example: try to call around and get maternity coverage on an individual policy, no insurance plan will sell you such coverage EXCEPT Kaiser.

[livecontent]

I have been with Kaiser Permanente for one and off 19 years and it has many advantages:

It has electronic records which many practioners have yet to adopt. So, when you go to a specialist, he knows exactly all the problems, all your history, has all xrays. In other insurance, the just asked you why you been referred and he has very little records.

It has an expanding online system you to view some of your own records--medications, tests results, heallth conditions. In addition, you can readily email a physician or a nurse and can an answer online. Private Physician want to see you; so they can get paid.

Today, you can go to a specialist without a referrel; have choices of many doctors and clinics. You do not like one, see someone else--it is your decision and can be made without approval. It is easy to get a second opinion; I have done it on numerous times.

On the weekend, on holidays there is an extensive system to call for help, advice and access. There are doctors, pharmacist, nurses available to help you at all times. In most other insurances, in an urgent care or an emergency, you go to a clinic that does not have your extensive medical records online; does not know your physician; cannot make contact readily. If you go to Kaiser, after hours, all records are available and the visit is recorded and it is sent to your primary care physician. Many times depending on the problem, next day, I got a call from the nurse to inquire about the problem and to follow up.

When you need information on drugs, you are connected to a pharmacist whose job is to answer phone questions--he is not working at a pharmacy so you get better attention. In addition, Kaiser has dedicated Pharm D Pharmacist working at all the clinics with all the doctors to oversea medications, give advice to doctors, and you can contact these specialist to discuss your problems. How many private doctors have a assigned Doctor of Pharmacy assigned to help them keep current on medications?? Most patients do not know that these Pharm D positions exist in every clinic separate, from dispensing pharmacist.

Mental Health is good because you are treated with a team: a psychologist, a psychiatric nurse and a Psychiatrist in a clinic with other Psychiatrist, so you also can get help. Private Psychiatrist work as lone wolfs and have no suppemental support.

If you have a complaint, there is a system in place to handle problems, with multiple reviews. Try complaining about your private physician, he will tell you to go somewhere else.

Many private physician networks doctors are picked because they are willing to take the payment schedule, not because they are the best available. There is very little review of performance or oversite of these physician because they are working independently.

Kaiser Physician are competitive hired by the Permanente Medical Group, a for profit medical practice, that provides service only to Kaiser. There is competition for positions, so better doctors are hired. and there is oversite by physician, supervisors and managers.

When you go to a private physician, his support staff may be lacking and you may find unqualified personnel giving you advice, with no qualified nurses, when the doctor is busy. In Kaiser, you may be received by a less educated support person, such as a Medical Assistance but there is always a Registered Nurse there to supervise. In addition, when you call, email, for advice direct to the any primary care office or specialist, you are connected to a Registered Nurse who job in to provide this service and is not being interrupted by patient care. Call a private physician and the receptionist will relay information to a doctor and sometimes, illegally, give advice, many times there are no RNs.

A very important aspect of care with Kaiser is that in most treatment, there is no bills. In private insurance their are multiple bills and many times the reimbursement is wrong. From my experience, it is done on purpose, and if you complain, they will pay the right amount but they know that many patients are too sick, tired or do not bother to dispute the charges. It is a nightmare to manage all these bills, especially when you are ill. With Kaiser, that headache does not exist.

Private Physician networks with for profit medical plans do not have the facilities, administration, or desire to provide extensive team care. Kaiser is non-profit and does try to provide more care but it is tied to a for profit medical group--Kaiser does not make that known and it has certain issues relating to for profit medical group that Kaiser deceptively hides under their marketing of Non-Profit, which is not totally true.

It certainly has problems; it does take time to get use to the service; it does require you to become familiar with the system and be your own advocate and speak up when you feel you are not be adequately treated. However, in my experience, with my extensive medical problems; other insurance plans and private insurance physicians networks are far worse.

Livecontent

[JourneyCC]

Thanks! This is very helpful, great info Live Content (echoing your sentiments).

[Sarah_in_Denver]

Originally Posted by tfox

One advantage of Kaiser, as opposed to other systems, is that it may be your only option in attempting to acquire certain types of coverage on an individual (as opposed to group) basis. One example: try to call around and get maternity coverage on an individual policy, no insurance plan will sell you such coverage EXCEPT Kaiser.

Absolutely incorrect. I used to work for Kaiser Colorado and have friends that still do. The individual plans no longer cover maternity coverage. They also don't cover prescription drugs. It's heartbreaking to talk to a member with individual coverage and hear them say, "I'm pregnant, what coverage do I have?" Absolutely none. And having a baby is a $20,000+ process lately.

You can get individual coverage if you have NEVER been sick, NEVER taken a medication for any illness, etc. You must be in perfect health. All applicants must go through health review, and if you've ever had an illness, you will be rejected. And if you get an individual plan, you still have the above listed restrictions.

I have Kaiser with my current job. I cannot see my PCP on the same day for any reason, no matter how sick I am, because he is so busy. However I won't switch PCPs, because the others I've seen (4) hate their jobs and patients. I've been sent to the ER 3 times for things that I consider treatable in a doctor's office. I've been told the wait for ENT is 3 months, even when my neurologist pushed the referral as emergency. Orthopedics is a 5 month wait, and I was only seen quickly after complaining to my HR, who complained to a VP at Kaiser. I have filed 3 complaints with the Colorado Division of Insurance. Kaiser does not care and does just enough to be compliant with the law, but still screws the patient.

And I have friends that still work there. Friends who were using all their contacts to help me. And I still got poor health care. What happens to people with complex medical problems who don't know people inside the company?

When I worked there, the Liaison department handled all major complaints. They still do. By law, they had to be taken care of in 2 weeks or less. They were always out of compliance because of the turn over in the department. They are not patient advocates, and there are none at Kaiser. The liaisons are there to follow the law, write you a letter explaining how they followed the law, and to make you go away. Don't be fooled that they are working for you. They are working for Kaiser.

Open enrollment has allowed me to switch plans. I'm so thankful I can get out of Kaiser, because I've been seriously concerned about my health if I stayed. I have a genetic condition that Kaiser docs agree is there, but don't want to manage (they send me to the ER instead).

And yes, part of Kaiser is non-profit. The side that is the administrative side. The part that has the doctors is for-profit. The non-profit side made so much money last year that they bought a building and are remodeling it. The alternative was to give it back to the members, and there's no way in hell they would ever do that.

Choose Cigna. Choose anything but Kaiser.

[tfox]

Originally Posted by Sarah_in_Denver

Absolutely incorrect. I used to work for Kaiser Colorado and have friends that still do. The individual plans no longer cover maternity coverage. They also don't cover prescription drugs. It's heartbreaking to talk to a member with individual coverage and hear them say, "I'm pregnant, what coverage do I have?" Absolutely none. And having a baby is a $20,000+ process lately.

Sorry... my info was a few years old. We did get Kaiser briefly because the offered an individual plan with maternity several years ago, but we have since moved onto group insurance.

[BarryK123]

Originally Posted by livecontent

Many private physician networks doctors are picked because they are willing to take the payment schedule, not because they are the best available. There is very little review of performance or oversite of these physician because they are working independently.

Kaiser Physician are competitive hired by the Permanente Medical Group, a for profit medical practice, that provides service only to Kaiser. There is competition for positions, so better doctors are hired. and there is oversite by physician, supervisors and managers.

Do you work for Kaiser?

As a physician, I believe the opposite is true.

Kaiser physicians are beholden to their employer - Kaiser. They constantly must think of the bottom line - skimp and provide the least expensive care, minimize diagnostic tests, etc. - or risk being out of a job. HMO physicians get paid by capitation - a flat fee, per patient, per month, with deductions to that fee each time they refer someone to a specialist and each time a diagnostic test is ordered. It's a reverse incentive system - get paid more for doing less.

Independent physicians are just that - independent. There is freedom of choice. If I don't like an insurance company's fee schedule, or they keep "losing" claims, I don't sign or renew a participation agreement with that company. While the system may not be perfect, independent physicians are able to be the patient's advocate and do what's appropriate.

IMO, it's the "bottom of the class" that becomes an employee of a company like Kaiser, and the "better doctor" is the one who remains independent in control of his/her own decision-making and destiny.

[livecontent]

Originally Posted by BarryK123

Do you work for Kaiser?

As a physician, I believe the opposite is true.

Kaiser physicians are beholden to their employer - Kaiser. They constantly must think of the bottom line - skimp and provide the least expensive care, minimize diagnostic tests, etc. - or risk being out of a job. HMO physicians get paid by capitation - a flat fee, per patient, per month, with deductions to that fee each time they refer someone to a specialist and each time a diagnostic test is ordered. It's a reverse incentive system - get paid more for doing less.

Independent physicians are just that - independent. There is freedom of choice. If I don't like an insurance company's fee schedule, or they keep "losing" claims, I don't sign or renew a participation agreement with that company. While the system may not be perfect, independent physicians are able to be the patient's advocate and do what's appropriate.

IMO, it's the "bottom of the class" that becomes an employee of a company like Kaiser, and the "better doctor" is the one who remains independent in control of his/her own decision-making and destiny.

No, I do not work for Kaiser. I also do not buy into many of the premises that you present just because you are a physician.

Kaiser does not require a referrel to a specialist in the plan I am on, so there is no way a primary care physician can the referrel. I decide just when and how often I go to a specialist, for the condition that I determine, and I go to many. I advise my primary care physician when I see him, out of courtesy, respect and to get advice, what I intent to do; if it is not an emergency. At no time has he objected.

I was also a member of Kaiser in other plans when a referrel was required; I never was denied referrel when I asked.

For the record, I do not always agree that there should be self-referrels to specialist because it is sometimes abused by over obsessive patients. I am intelligent enough to make the decision and ask the advice of my primary care physician but some are not.

When I have been referred to a specialist from an independent physician, sometimes it was done in a casual way by the receptionist who just looked up a physician on the insurance carriers list.

In addition, Kaiser constantly advocates for tests and encourages patients to get the approriate test. I just got a call, a few days ago, from Kaiser, a computer generated call, to encourage me to get a colonoscopy because I fit the profile for age.

From my experience, independent physician have shown me no better care and I can see that many signed up for all the insurance plans they can take, even though the practice could not handle the patients. In addiition, they lack the support network, pharmacist and professional nurse assistance and rely on minimally trained staff.

I saw no indication that independent physicians are more caring or advocate for the patient more than the Kaiser Physicians.

I have spend more time dealing with double billing from physicians, over billing from indepedent physicians that certainly indicated a pattern of fraud from some groups; they hope that many patients do not care or cannot understand the billing.

In addition, In all my independent hospitals stays and emergency have been overcharged and required me to protest and in all cases the billing was adjusted. The insurance carrier continually paid the wrong reimbursement rate, always to their favor--hoping that the patient was too sick or ignorant to notice.Again a pattern that does not speak to me of just mistakes. With Kaiser, there is very few direct billing, so I am protected from these hazards.

The independent physician may or not be better physician but I am saying there is no oversight by the contracting insurance carriers in the physicians they put on their approved list, so you get good and bad. Kaiser exercise more control because they hire the physician directly and there is oversight. Independent physician are beholding only to themselves or their group practice.

I am a very informed consumer of health care because I had to learn to protect myself and get the care I need. Today, patients are more educated; more knowledgeable, and do not accept blindly the dictates of the gods of medicine because we know that they sometimes have clay feet.

Livecontent

[BarryK123]

Originally Posted by livecontent

In addition, Kaiser constantly advocates for tests and encourages patients to get the approriate test. I just got a call, a few days ago, from Kaiser, a computer generated call, to encourage me to get a colonoscopy because I fit the profile for age.

There's one and only one reason for this. Same is true of HMOs offering year-end bonuses to their primary care docs to get their diabetic patients in for an eye exam. It's also the same reason EVERY baby in the US is tested for PKU - an incredibly rare disease. Their number crunchers have determined that it's cheaper to do the testing and catch and treat the disease in its early stages rather than pay for treatment of the complications later, which costs them more money.